Region III Championship JO Form
Region III
Name Last
First
Address:
City:
State:
Zip:
Region:
1
2
3
4
5
6
7
8
9
Phone:
Other Phone:
Contact Email:
Number of years as a Judge:
How many Regional Championships have you judged:
Current Judges Rating:
Pro #
Safety cert.
Safety
Exp. Date
JO Meets Judged this Season & Dates
Event Judged
1)
2)
3)
4)
5)
6)
If chosen, preferred mode of travel to this year's Regional Championships.
If flying, nearest usable airport to depart.
When you have completed the form, please print and return it to the State Chairman who made the request. You can get their address on the Region III website at:
www.region3men.org\addresses.htm